Monday, April 9, 2007

How to Recover From Repetitive Stress Injuries

Most people who work on a computer for a living will end up with some sort of repetitive stress injury such as Carpal Tunnel Syndrome or Wrist Tendonitis.This year I’ve had the uncommon experience of experiencing Ulnar Tunnel Syndrome, Golfer’s Elbow, Tennis Elbow and Wrist Tendonitis simultaneously.It takes a lot of work, and a measure of luck, to acquire all of these injuries at once. The recipe is as follows:

Work on a computer for years with constant use of keyboard and mouse. Slouching and other poor body positioning helps. Place your forearms on the edge of the table so there is a constant sharp pressure along the bottom of your arms.

Find a vertically overhanging roof and suspend yourself by hands and feet underneath it. Put all of your weight on one shoulder and twist till you feel grinding popping noises.Repeat three or four times because you really want to finish the climbing route! You’ll know when you have it right when your shoulder is hurting badly and it is hard to lift your arm.

Continue climbing but favor your hurt shoulder and place extra stress on your elbows. Over a couple of weeks you’ll develop a burning pain on the inside of both elbows that sticks with you day and night.

Go skiing with a 5 year old child (borrow one if you don’t have one). Place the child on a steep slope and watch them accelerate toward certain death. Ski toward the child at a very high rate of speed and Superman-tackle them so that you can save them from certain death. You are likely to lose at least one ski on impact and begin spinning wildly out of control. As you approach an obstacle (sign, tree, pole, etc) hit it with your elbow and back in order to spare the child from imminent injury. Extra points if your wife catches the whole thing on video.

Go skiing again with the 5 year old child. Since you’ve learned from the last experience, place the child on an easier slope and talk encouragingly. Ski sideways alongside the child so you can monitor their progress carefully and avoid another Superman incident. Catch an edge and instantly reduce speed from 20 mph to 0 mph via body flop and face/snow friction. Extra points if you hit with enough force to break your goggles.

Repeatedly hit the back of your elbow on walls, chairlifts, car doors, tables and countertops.

That should pretty much do it!You’ll know you have the injuries if you have constant pain on the insides and outsides of both elbows, numbness in your fingers and palms, pain in your wrist when bending it and so little strength that it hurts to wash your face.

Now that you have the same set of injuries I do, I can give you advice on how to recover.I spoke with multiple doctors, a physical therapist, and even visited an acupuncturist in a quest to bring you the most accurate and up to date information possible. I am not yet fully cured, the recovery process is more time consuming than the injury process, but I’ll pass along what I’ve learned in hopes that it will speed your recovery:

Make sure your workstation is ergonomic. Ergonomics information is widely available on the web so I’ll just give you the basics. Use plenty of padding to reduce pressure spots, focus on good posture in your seat, orient your monitor so that it is just above eye-level, and set your desk/chair height so that your arms fall naturally to the keyboard and mouse without unnatural reaching or shoulder hunching.

Buy a pair of IMAK Smart Gloves and wear them religiously. Ok, you’ll look really dorky if you wear them in public, so don’t do that. But wear them whenever you are at your computer and when you are sleeping. When you are working wear them padded side down so that you stay comfy and your wrists have no strain on them. When you are sleeping wear them splint side down so you are not able to curl your hands in and further inflame your tendons and nerves.

While you are on the IMAK site also buy wrist supports for mouse and keyboard. These will keep you from putting pressure on your arm’s nerve branches and allow your Ulnar or Carpal tunnel to start healing.

Buy Dragon NaturallySpeaking 9 speech recognition software. You’ll spend 30 minutes setting it up and then will be able to dictate most of what you write and save your arms from the repetitive stress pummeling that helped get you in this predicament to start with.

In order to improve speech recognition accuracy, buy a high quality microphone such as the Sennheiser ME3. You may feel like Britney Spears when you wear it, but your dictation accuracy will become markedly better.

Stretch 3 or 4 times per day. Put your hand up against a wall and bend your wrist outward, stretching so that you feel it your inner forearm and elbow. Next use one hand to bend the other hand in and stretch your outer forearm and elbow. Finally put your hands together as if you were in a praying position and extend the stretch downward until you feel it in your forearms. Hold each stretch for 20 seconds and repeat 2 times per arm. Stretch so it is mildly uncomfortable but no further, it’s possible to overstretch your tendons and nerves causing additional damage.

After you stretch, give yourself a friction massage on the affected tendons. Rub crosswise against the tendons, not lengthwise. Press firmly enough that the tendons move around but not so hard that there is pain. Massage for approximately 30 seconds around the bony knobs on the inside and outside of each elbow. If you have injuries to both elbows, the arm giving the massage may hurt more than the arm receiving it. If that’s the case, use a massage helper such as the TheraCane massager.

Heat or ice depending upon your level of inflammation. Press the bony knobs on either side of your elbows. If they are painful to the touch use ice, if they are not painful use heat. Ice or heat for 15-20 minutes per elbow.

Once you are on the road to recovery start arm exercises to strengthen the tendons and muscles. Wrist flexions, bicep curls and pushups all work well. Use low weights and high reps to protect the tendons. Exercising 3 times per week using 3 sets of 20 per exercise works well.

Tips

Inflammation in tendons takes a long time to reduce and is very easy to re-inflame.At the slightest sign of aggravation, stop what you are doing and rest for a while.

Take anti-inflammatory drugs such as ibuprofen for 3 or 4 weeks to get a head start on the inflammation.

During the weeks you are taking ibuprofen go easy on your arms, don’t exercise and work as little on a mouse and keyboard as possible.

Be careful about going to an acupuncturist.My experience was like being mercilessly stung by a dozen bees.I’ve heard it works well for some people.If repeatedly inserting cold steel into your body seems like a counterintuitive method of healing, skip acupuncture.

Be patient, it took a long time to gather the injuries, it’ll take at least as long to heal from them.

If you follow these tips for several months you should be well on your way to health and ready to get out there and acquire a whole new set of interesting injuries!

I'm happy to report that I am now fully recovered. It took me most of year for all the pain to go away, but the routine I described really did work for me.

Since then I've gone through 3 different keyboards trying to find the one that works best for me. I've used a Microsoft ergo keyboard, a Logitech wave, and now I'm trying an Apple aluminum keyboard. So far the Apple feels the best, even if it looks less ergonomic, but I'll need more time on it to be certain.

I do still write code, but as a manager, I no longer spend my entire day programming. Speech recognition works very well for emails, documents and the like but not so good for code!